Immediate Implant for Bruxer?
Sixty-five year old man is a bruxer, as shown in Fig.1, 2 (upper. lower arch, respectively, mirror view). He has a night guard. Fig.1-3 and Fig.4,5 are taken before and after crown fracture of the tooth #9, respectively. It appears that the tooth is nonsalvageable.
Although gutta percha of #9 is overfilled, there is no active infection (Fig.3,4). Can we place an implant immediately after extraction without loading or minimal loading?
I am not a big fan of immediate implant. I have done a few case. If you do transmucosal implant, your implant is smaller than the original socket opening. You have a wider open gap for the fibrin clot to fill. Primary closure is always preferred for transmucosal implant. That is one of the reasons. Also if you let the socket heal for a few weeks, the cribiform plate starts to turn over and heal at the most active phase. That is the prime time for implant placement too.
What do you gain by doing immediate implant while you still can not restore immediately. Patient still has to function with transitional devices. You better off make a better transitional device let the socket heal, and then do implant. I am not aware of any orthopedic surgeon asking their patient run the day after the surgery.. This patient is a bruxer, implant is not immune to occlusal trauma.
A good immediate implant case should be to restore a very small teeth , e.g. lateral incisor.
Xin Wei, DDS, PhD, MS 1st edition 09/06/2011, last revision 09/07/2011